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MONITORING WELL INSTALLATION REPu. ,r <br /> Date: 6 1 ,7 CONSTRUCTION <br /> Premise Address: y i �� �j l o�y(� Total Depth 2 <br /> Screen Length (from) (to) o <br /> Well No.: w Filter Pack (from) i (to) <br /> Bentonite (from) (to) o <br /> Inspector: ��f f,r j�j�1/ Grout (from) (to) <br /> Drilling rig type <br /> Permit No. �T=� L (7 Auger O.D. `" I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: � i��Lu C <br /> Driller: �(j. ( 1 yA t A�f VAXW�o casing <br /> height <br /> Consultant � �.land,�l` <br /> I V <br /> Geologist fdyr ._ <br /> VE-G R OUN <br /> N CHAISTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distancet sewer line grout <br /> Dome 'c well on si - (y/ n ) (v ✓ `�' <br /> If s, location distance - l <br /> ft. <br /> y. <br /> C <br /> SAMPLING = <br /> slotted —_ � <br /> Holding Temperature <br /> Method _ VIVW Pack <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) <br /> ZS �v ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type silt, ItO r V L <br /> Blank ft. Screen ft. <br /> Kn,W C V►Nt.�� Slot size <br /> GROUTING Bass cement 413 - E l�E <br /> t Buckets bentonite 'G <br /> Depth to water 7 Bags sand/gravel <br /> Mix Ratios 4 rS 4 IL 4.0 Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed k Discussed with geologist: - n ) <br /> Type of method <br /> EH 29 29 <br />